I’m often asked to give a lecture titled, “5 ways to offer Neuro-Protective Care Every Day.”
I love this lecture because it is so practical and really gets to the essence of what creating a NeuroNICU, NICN, Neuro-Nurturing or Brain-Focused NiCU is really all about.
Since every baby has a brain, and that the neonatal brain is undergoing such rapid and critical early development, right under our noses we must truly believe that – Every NICU is a “Neuron-Nurturing” NICU. For me, Neuro-Protective Care Practices are just about providing a nurturing and nourishing environment – minimizing the negative stressors and maximize the positive sensory experiences.
The 5 areas that I focus on in my lecture are as follows:
1. Prevention of primary brain injuries.
Neuro-protection isn’t just about preventing IVH with midline head positioning. I encourage you to rethink your programs for preventing NEC, CLABSI, HAI, BPD, ROP, CLD, VAP as neuro-protective interventions too. Late-sepsis, NEC and extended time on mechanical ventilation have all been associated with white matter abnormalities and place an infant at higher risk for CP after discharge.
2. Minimize the spread of brain injury through therapeutic hypothermia and seizure management protocols both help to minimize additional damage to an already sick or injured brain. For example:
- Do you know the average time your infants reach target temp (33.5C)?
- Do you treat seizures like a “brain code” and track the time it takes to give the first dose of phenobarbital?
- Do you have a protocol to read aEEG every few hours?
In the future we will have additional nutritional and pharmaceutical agents to offer infants with brain injury such as those described in last month’s Top Takeaway Series – Neuro-Monitoring.
3. Minimizing pain and stress exposures and parental separation during the entire NICU stay.
- Do you track the number of stressful or painful exposures your babies have in the NICU? Are parents part of the care team?
- Do you track the use of sucrose?
- Do you use essential oils in your NICU? for NAS babies?
4. Maximizing positive sensory experiences, like maternal/parental skin to skin holding (yes, even during painful procedures).
- Do you know how many hours of skin to skin your babies get in the first 14 days of life?
- Do you teach parents the importance of touching and talking to their baby during a painful experience?
- Do you have comfortable chairs for parents?
- Many of us still don’t have the luxury of private NICU rooms – Can you offer privacy?
- Do you have a developmental care team? Do you have a music therapist? Designated NICU OT, PT, SLP or Developmental Specialist?
5. Providing mental health services to parents in the NICU.
Studies show that parents of NICU babies are at risk for PTSD, anxiety and depression.
- Does your NICU have a standardized mental health assessment?
- Do you have a psychologist or social worker who can work with parents who need therapy while their infant is in the NICU?
- Do you have peer to peer or staff lead support groups?
Want to learn more about nurse mental health? Check out our Synapse Spotlight featuring Michelle Waddell, BSN, RNC-NIC.
As you can see, even these 5 areas offer endless opportunities for examining and improving our practice.
In the end, what matters is what you do in your NICU, with your equipment, with your staff, families, and community. What I love to see is one NICU compare themselves to themselves over time. You can not improve if you don’t know where you are — It all starts with measuring, then planning, doing, and re-evaluating.
Not sure where to get started? Check out the “Transforming Research into Practice in the Neuro-Nurturing NICU” section of the QuickStart Guide course.